Healthcare Provider Details

I. General information

NPI: 1710052766
Provider Name (Legal Business Name): NOVA SOUTHEASTERN UNIVERSITY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

IV. Provider business mailing address

PO BOX 290250
DAVIE FL
33329-0250
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-7750
  • Fax: 954-262-3987
Mailing address:
  • Phone: 954-262-7750
  • Fax: 954-262-1172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT OLLER
Title or Position: CEO/CLINICAL OPERATIONS
Credential: D.O.
Phone: 954-262-4343